Tai Chi, Qi Gong, and Other Complementary Alternative Therapies for Treatment of the Aging Spine and Chronic Pain

21 Tai Chi, Qi Gong, and Other Complementary Alternative Therapies for Treatment of the Aging Spine and Chronic Pain



Wei Huang, Alice Fann, Linqiu Zhou, Weibin Yang, Chunbo Cai, James J. Yue




KEY POINTS



• Various complementary alternative therapies based on movements, energy, and mind-body interactions are used in the treatment of older patients with spine conditions and chronic pain to decrease pain, improve function, and maintain general health. Many times, they are used in combination with more traditional treatment modalities.

• Movement-based therapies such as Tai Chi (“Tai Ji Quan”) incorporate balance training, mind concentration, breathing techniques, and core muscle strengthening to improve spine function and to promote general health.

• Energy-based therapies and mind-body interactions may take advantage of the use of attention in their effective management of chronic nonmalignant pain in older patients.

• Clinical application of these complementary alternative therapies is promising, but requires diligent guidance and monitoring from providers to ensure safety and benefits, as there are no definitive practice guidelines that are supported or not supported by currently available clinical trials.

• Mechanistic research on these modalities is challenging, due to the complex interplay of central, autonomic, and peripheral nervous systems when these therapies are applied.


Introduction


Among patients with spine conditions and chronic pain, there is an increasing use of complementary alternative therapies that are considered to be “holistic,” noninvasive, and nonpharmaceutical. Such therapies are either used as alternative options or as complementary modalities to medical techniques and/or pharmaceutical agents that are known and accepted by the majority of “conventional” medical practitioners. This chapter will introduce some of these referred complementary alternative therapies, including therapies based on movements, energy, and mind-body interactions. Although complete understanding of the physiologic basis for these therapies is still limited, this chapter provides basic concepts and clinical guidelines about Tai Chi, Qi Gong, and other energy-based therapies, as well as some mind-body interaction practice such as mindfulness meditation, guided imagery, and spirituality practice. It will also delineate some basic science studies that may explain some of their clinical effects. Using a clinical case example, we will demonstrate the selective use of such therapies in a comprehensive pain management plan to improve clinical success. Certain clinical practice-related issues will be reflected in case discussion. Readers are advised to view this chapter only as an introduction to these complementary alternative therapies; by no means do we try to cover all inspirations, debates, and scientific investigations of the topic.



Tai Chi


It is easy to associate Tai Chi with those slow, deliberate movements performed in synchronization by groups of elderly people in parks. Strictly speaking, so-called Tai Chi in the Western world should be Tai Ji Quan in the Chinese Pinyin system or Tai Chi Chuan in Wade-Giles transliteration. “Tai Chi” itself is, rather, a concept in Chinese Taoist philosophy where Yin and Yang, although being the two opposite “supreme ultimate” forces, infiltrate and reconcile each other to unite as a single universe. Tai Chi Chuan originated in China about 600 years ago as a form of martial arts and was once one of the most powerful forms of combat. It was named after Tai Chi as “the Supreme Ultimate Boxing” because its movements are based on Yin-Yang Tai Chi philosophy to feature a defense system that applies the force from an assailant to fend off the attack without deliberate killing. By convention, the term Tai Chi will be used to refer to Tai Chi Chuan in this chapter.


There are five main styles of Tai Chi: Chen, Yang, Wu (or Hao), Wu, and Sun. Although each style has different speeds and forms of movements, practicing any style of Tai Chi requires similar fundamentals, including (1) concentration with internal stillness and quick reaction time, (2) deep breathing skills to enhance its aerobic component, (3) strong leg support and good balance for constant body weight shifting during movements, (4) correct posture and spine alignment with relaxed muscles to maintain stability without unnecessary muscle tension, and (5) an agile torso (lumbar spine) with coordination among all body parts to perform the movements gracefully. Masters of Tai Chi build up internal energy that gives them not only the power needed during combat, but also health and longevity. The latter is the main reason why Tai Chi is widespread in the world, with many participants being attracted to it not for its combative content but for its health benefits. When it is performed for health reasons, the movements can be slow and deliberate with low exercise impact and, therefore, can be tolerated well by the elderly (Figure 21-1).


image

FIGURE 21-1 When performed for health reasons, the movements of Tai Chi can be slow and deliberate, with low exercise impact.


Compared to other types of exercises, Tai Chi involves more weight bearing and strength training than yoga and a wider range of coordinated movements than other aerobic exercises. Even in low-impact Tai Chi, emphasis is placed on correct posture and spine alignment with appropriate muscle relaxation. Such features make Tai Chi a good therapy for patients with chronic back pain. Although no randomized controlled clinical trial was found in the literature using Tai Chi for spine conditions, clinical benefits have been observed including strengthened core muscles, increased functional range of motion, decreased pain level, and improved quality of life.


Even with simplified Tai Chi exercises, studies have demonstrated improvement in balance, reduced fear of falling, and decreased risk of falls in older adults.1 Tai Chi, like other forms of exercise, can also reduce blood pressure, improve heart failure, normalize blood lipids and glucose levels,2 and positively affect bone mineral density in postmenopausal women.3 In the older population, when compared to age and body size-matched sedentary controls, Tai Chi practitioners have higher oxygen uptake, greater flexibility, and a lower percentage of body fat.4



Clinical Practice Guidelines


Because there are different levels of Tai Chi forms, from those commonly practiced by the elderly to those practiced by combat martial artists, recommendations for patients with spine conditions have to be individualized. Basic Tai Chi forms can be tolerated well by the elderly who are not active or do not have good balance or coordination; these forms focus on lower body strength and good posture that will improve balance and coordination. Intermediate levels of Tai Chi forms can improve core muscle strength, cardiovascular tolerance, and pulmonary function. Combat levels of Tai Chi forms are not recommended until patients have developed excellent balance and coordination as well as strong core muscle strength; this form should only be practiced under the guidance of Tai Chi masters and with close monitoring of physicians because some of these forms can cause sports-related injuries.


Tai Chi instructors are certified after undertaking a certain amount of training and participating in teaching for a certain number of hours; however, the amount of each needed varies with the different certifying institutions. The certification process is not regulated by legislation. A good reference is important before sending your patients to a particular instructor, preferably one with experience in teaching patients with spine conditions.



From Qi Gong to Energy-Based Therapies


Qi Gong (“Training of Qi”) is a form of energy therapy, energy therapies being those that use and/or manipulate bioenergy or “Qi” fields for medical treatment purposes. The concept of energy therapy is based on the theory that there are patterns of Qi flow in human bodies; the disruption of such patterns of flow can lead to dysfunction and disorders. No one can observe Qi itself, but it has been claimed to be able to “move” around the body and to defend certain body areas. For example in Qi Gong performance, a practitioner resists a sharp weapon, such as the tip of a piercing spear, at his throat by moving his Qi towards that area. Qi has also been perceived when there is “blockage.” A clinical example of such is when a patient presents with a complaint of “having poor circulation.” The symptoms typically are cold, numb fingers and toes; conventional medical tests for nerve function, blood flow, vitamin levels, and endocrine pathology all turn out to be normal. In Traditional Chinese Medicine, such a patient has a problem of Qi “blockage”; therefore energy cannot “flow” toward the distal extremities. The principle of energy therapy is to restore the normal “flow” of Qi or the human bioenergy field for disease prevention or treatment.


Qi Gong originated in China, under the influence of meditation and martial arts practices. Qi Gong masters claim to be able to move energy along meridians for their own health and possibly to heal others’ illnesses. However, driven by financial profit, some inauthentic Qi Gong “masters” also claim to be able to heal and may fool the public. In those cases, certain clinical improvements of the treated patients are likely contributed by acupressure massage, mind-body interactions, psychological placebo effects, and/or the benefits of touch. Some personal conversation between one author (WH) and a well-known Qi Gong master revealed that using energy to heal others hurts the practitioners themselves and thus is rarely practiced except in emergency situations. Therefore, Qi Gong masters usually would rather teach people how to control their own Qi to run smoothly along meridians to maintain health and achieve self-healing.


Besides Qi Gong, other main types of energy-based therapies include Reiki (Japanese), Breema (American), and therapeutic touch (American). Some of these are critically questioned by the research community. For instance, in therapeutic touch, practitioners with their hands placed several inches to feet away from a patient claim that they can feel the energy field emanated by a human body and detect certain patterns of disruption; however, in one clinical investigation, they could correctly detect only 44% of the time (less than chance) the position of a child’s hand.5 Although this illustrates certain doubts on energy-based therapies for their bioenergy base, we are not rejecting their clinical effects as the possible effects may be achieved in other ways.



Clinical Practice Guidelines


Energy-based therapies have been used in chronic back pain in the elderly for myofascial release, pain relief and coping, and improvement of depression. Whether such therapies are truly bioenergy based is currently not clear. Clinical application should be practiced cautiously according to each individual’s condition.


Some forms of energy therapy such as Qi Gong are not recommended for self-practice without guidance. Cases of “energy maltracking during practice” with psychological reactions have been reported around the world. These cases present with symptoms interpreted by mainstream psychiatrists as psychosis or schizophrenia. In bioenergy-based theory, such incidences are thought to be induced by energy invasion into certain meridians without proper guidance. In the clinical psychiatry point of view, such incidences occur with meditation psychosis.



Mind-Body Therapies


Mind-body therapies use the power of the mind to make positive changes in the body and improve health. The practice of such power might be traced back to ancient Buddhist philosophy and practice; the use of it for healing has been recent, with various approaches. We will introduce here a few of the available therapies that are better known to the public.



Mindfulness Meditation


The mindfulness-based stress reduction (MBSR) program was developed at the University of Massachusetts Medical Center. Mindfulness meditation has three purposes: knowing the mind, training the mind, and freeing the mind. It calls for awareness of conscious and unconscious thoughts, feelings, and behaviors that underlie emotional, physical, and spiritual health, and cultivates greater awareness of one’s own bodily functions for the unity of mind and body. The mind is known to be a factor in stress and stress-related disorders. In mindfulness meditation, patients learn to distinguish between mind and awareness, learn to see how the mind dwells on anxiety and fear that burns up energy, learn to stay in the present moment while experiencing high levels of pain, and learn to distinguish between pain sensations and the mind’s creation of the experience of suffering. The practice thus brings nonjudgmental moment-to-moment awareness to thoughts, sensations, or emotions as they arise.


In one qualitative study, 27 older adults with chronic low back pain participated in a MSBR program.6 The authors found a report of improved attention, improved quality of sleep, and improved quality of life along with reduction in pain. In another randomized controlled study of 37 older adults with chronic pain, subjects were randomized into MSBR or wait-list control groups. MSBR participants were found to have improvement in pain acceptance, activity engagement, and physical functioning after 6 months.7 Both studies showed that MSBR was feasible and effective in the older adult population with spine conditions and chronic pain.


Mindfulness meditation is usually taught in weekly group classes that require daily practice outside the group setting for an intensive 8 weeks. It can include sitting, walking, loving-kindness, or body-scan type of meditation. The students are usually given guided meditation tapes for assisting with meditation techniques and are required to practice daily afterwards.

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Aug 6, 2016 | Posted by in NEUROSURGERY | Comments Off on Tai Chi, Qi Gong, and Other Complementary Alternative Therapies for Treatment of the Aging Spine and Chronic Pain

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